Organization
CBC, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY YESSENOW MD (CO-PRESIDENT)
(219) 756-0600
Entity
Organization
Contact information
Practice address
5355 COMMERCE BOULEVARD, CROWN POINT, IN 46307-5325
(219) 756-0600
(219) 756-0608
Mailing address
5355 COMMERCE BOULEVARD, CROWN POINT, IN 46307-5325
(219) 756-0600
(219) 756-0608
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
080107642
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000566567
ANTHEM
—
Enumeration date
03/04/2008
Last updated
09/10/2018
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